Incidence of perioperative medical complications and mortality among elderly patients undergoing surgery for spinal deformity

analysis of 3519 patients

International Spine Study Group

Research output: Contribution to journalArticle

Abstract

OBJECTIVE Using 2 complication-reporting methods, the authors investigated the incidence of major medical complications and mortality in elderly patients after surgery for adult spinal deformity (ASD) during a 2-year follow-up period. METHODS The authors queried a multicenter, prospective, surgeon-maintained database (SMD) to identify patients 65 years or older who underwent surgical correction of ASD from 2008 through 2014 and had a minimum 2 years of follow-up (n = 153). They also queried a Centers for Medicare & Medicaid Services claims database (MCD) for patients 65 years or older who underwent fusion of 8 or more vertebral levels from 2005 through 2012 (n = 3366). They calculated cumulative rates of the following complications during the first 6 weeks after surgery: cerebrovascular accident, congestive heart failure, deep venous thrombosis, myocardial infarction, pneumonia, and pulmonary embolism. Significance was set at p < 0.05. RESULTS During the perioperative period, rates of major medical complications were 5.9% for pneumonia, 4.1% for deep venous thrombosis, 3.2% for pulmonary embolism, 2.1% for cerebrovascular accident, 1.8% for myocardial infarction, and 1.0% for congestive heart failure. Mortality rates were 0.9% at 6 weeks and 1.8% at 2 years. When comparing the SMD with the MCD, there were no significant differences in the perioperative rates of major medical complications except pneumonia. Furthermore, there were no significant intergroup differences in the mortality rates at 6 weeks or 2 years. The SMD provided greater detail with respect to deformity characteristics and surgical variables than the MCD. CONCLUSIONS The incidence of most major medical complications in the elderly after surgery for ASD was similar between the SMD and the MCD and ranged from 1% for congestive heart failure to 5.9% for pneumonia. These complications data can be valuable for preoperative patient counseling and informed consent.

Original languageEnglish (US)
Pages (from-to)534-539
Number of pages6
JournalJournal of neurosurgery. Spine
Volume27
Issue number5
DOIs
StatePublished - Nov 1 2017

Fingerprint

Databases
Mortality
Incidence
Medicaid
Pneumonia
Heart Failure
Pulmonary Embolism
Venous Thrombosis
Stroke
Myocardial Infarction
Perioperative Period
Medicare
Informed Consent
Counseling
Surgeons

Keywords

  • adult spinal deformity
  • ASD = adult spinal deformity
  • CHF = congestive heart failure
  • CVA = cerebrovascular accident
  • DVT = deep venous thrombosis
  • elderly patients
  • ICD-9-CM = International Classification of Diseases, 9th Revision, Clinical Modification
  • major medical complications
  • MCD = Centers for Medicare & Medicaid Services claims database
  • Medicare claims database
  • MI = myocardial infarction
  • NIS = National (Nationwide) Inpatient Sample
  • NSQIP = National Surgical Quality Improvement Program
  • PE = pulmonary embolism
  • SMD = surgeon-maintained database
  • SRS = Scoliosis Research Society
  • surgeon-maintained database

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology

Cite this

Incidence of perioperative medical complications and mortality among elderly patients undergoing surgery for spinal deformity : analysis of 3519 patients. / International Spine Study Group.

In: Journal of neurosurgery. Spine, Vol. 27, No. 5, 01.11.2017, p. 534-539.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE Using 2 complication-reporting methods, the authors investigated the incidence of major medical complications and mortality in elderly patients after surgery for adult spinal deformity (ASD) during a 2-year follow-up period. METHODS The authors queried a multicenter, prospective, surgeon-maintained database (SMD) to identify patients 65 years or older who underwent surgical correction of ASD from 2008 through 2014 and had a minimum 2 years of follow-up (n = 153). They also queried a Centers for Medicare & Medicaid Services claims database (MCD) for patients 65 years or older who underwent fusion of 8 or more vertebral levels from 2005 through 2012 (n = 3366). They calculated cumulative rates of the following complications during the first 6 weeks after surgery: cerebrovascular accident, congestive heart failure, deep venous thrombosis, myocardial infarction, pneumonia, and pulmonary embolism. Significance was set at p < 0.05. RESULTS During the perioperative period, rates of major medical complications were 5.9{\%} for pneumonia, 4.1{\%} for deep venous thrombosis, 3.2{\%} for pulmonary embolism, 2.1{\%} for cerebrovascular accident, 1.8{\%} for myocardial infarction, and 1.0{\%} for congestive heart failure. Mortality rates were 0.9{\%} at 6 weeks and 1.8{\%} at 2 years. When comparing the SMD with the MCD, there were no significant differences in the perioperative rates of major medical complications except pneumonia. Furthermore, there were no significant intergroup differences in the mortality rates at 6 weeks or 2 years. The SMD provided greater detail with respect to deformity characteristics and surgical variables than the MCD. CONCLUSIONS The incidence of most major medical complications in the elderly after surgery for ASD was similar between the SMD and the MCD and ranged from 1{\%} for congestive heart failure to 5.9{\%} for pneumonia. These complications data can be valuable for preoperative patient counseling and informed consent.",
keywords = "adult spinal deformity, ASD = adult spinal deformity, CHF = congestive heart failure, CVA = cerebrovascular accident, DVT = deep venous thrombosis, elderly patients, ICD-9-CM = International Classification of Diseases, 9th Revision, Clinical Modification, major medical complications, MCD = Centers for Medicare & Medicaid Services claims database, Medicare claims database, MI = myocardial infarction, NIS = National (Nationwide) Inpatient Sample, NSQIP = National Surgical Quality Improvement Program, PE = pulmonary embolism, SMD = surgeon-maintained database, SRS = Scoliosis Research Society, surgeon-maintained database",
author = "{International Spine Study Group} and Amit Jain and Hamid Hassanzadeh and Varun Puvanesarajah and Klineberg, {Eric O.} and Daniel Sciubba and Kelly, {Michael P.} and Hamilton, {D. Kojo} and Virginie Lafage and Buckland, {Aaron J.} and Passias, {Peter G.} and Protopsaltis, {Themistocles S.} and Renaud Lafage and Smith, {Justin S.} and Shaffrey, {Christopher I.} and Kebaish, {Khaled M}",
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T1 - Incidence of perioperative medical complications and mortality among elderly patients undergoing surgery for spinal deformity

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AU - International Spine Study Group

AU - Jain, Amit

AU - Hassanzadeh, Hamid

AU - Puvanesarajah, Varun

AU - Klineberg, Eric O.

AU - Sciubba, Daniel

AU - Kelly, Michael P.

AU - Hamilton, D. Kojo

AU - Lafage, Virginie

AU - Buckland, Aaron J.

AU - Passias, Peter G.

AU - Protopsaltis, Themistocles S.

AU - Lafage, Renaud

AU - Smith, Justin S.

AU - Shaffrey, Christopher I.

AU - Kebaish, Khaled M

PY - 2017/11/1

Y1 - 2017/11/1

N2 - OBJECTIVE Using 2 complication-reporting methods, the authors investigated the incidence of major medical complications and mortality in elderly patients after surgery for adult spinal deformity (ASD) during a 2-year follow-up period. METHODS The authors queried a multicenter, prospective, surgeon-maintained database (SMD) to identify patients 65 years or older who underwent surgical correction of ASD from 2008 through 2014 and had a minimum 2 years of follow-up (n = 153). They also queried a Centers for Medicare & Medicaid Services claims database (MCD) for patients 65 years or older who underwent fusion of 8 or more vertebral levels from 2005 through 2012 (n = 3366). They calculated cumulative rates of the following complications during the first 6 weeks after surgery: cerebrovascular accident, congestive heart failure, deep venous thrombosis, myocardial infarction, pneumonia, and pulmonary embolism. Significance was set at p < 0.05. RESULTS During the perioperative period, rates of major medical complications were 5.9% for pneumonia, 4.1% for deep venous thrombosis, 3.2% for pulmonary embolism, 2.1% for cerebrovascular accident, 1.8% for myocardial infarction, and 1.0% for congestive heart failure. Mortality rates were 0.9% at 6 weeks and 1.8% at 2 years. When comparing the SMD with the MCD, there were no significant differences in the perioperative rates of major medical complications except pneumonia. Furthermore, there were no significant intergroup differences in the mortality rates at 6 weeks or 2 years. The SMD provided greater detail with respect to deformity characteristics and surgical variables than the MCD. CONCLUSIONS The incidence of most major medical complications in the elderly after surgery for ASD was similar between the SMD and the MCD and ranged from 1% for congestive heart failure to 5.9% for pneumonia. These complications data can be valuable for preoperative patient counseling and informed consent.

AB - OBJECTIVE Using 2 complication-reporting methods, the authors investigated the incidence of major medical complications and mortality in elderly patients after surgery for adult spinal deformity (ASD) during a 2-year follow-up period. METHODS The authors queried a multicenter, prospective, surgeon-maintained database (SMD) to identify patients 65 years or older who underwent surgical correction of ASD from 2008 through 2014 and had a minimum 2 years of follow-up (n = 153). They also queried a Centers for Medicare & Medicaid Services claims database (MCD) for patients 65 years or older who underwent fusion of 8 or more vertebral levels from 2005 through 2012 (n = 3366). They calculated cumulative rates of the following complications during the first 6 weeks after surgery: cerebrovascular accident, congestive heart failure, deep venous thrombosis, myocardial infarction, pneumonia, and pulmonary embolism. Significance was set at p < 0.05. RESULTS During the perioperative period, rates of major medical complications were 5.9% for pneumonia, 4.1% for deep venous thrombosis, 3.2% for pulmonary embolism, 2.1% for cerebrovascular accident, 1.8% for myocardial infarction, and 1.0% for congestive heart failure. Mortality rates were 0.9% at 6 weeks and 1.8% at 2 years. When comparing the SMD with the MCD, there were no significant differences in the perioperative rates of major medical complications except pneumonia. Furthermore, there were no significant intergroup differences in the mortality rates at 6 weeks or 2 years. The SMD provided greater detail with respect to deformity characteristics and surgical variables than the MCD. CONCLUSIONS The incidence of most major medical complications in the elderly after surgery for ASD was similar between the SMD and the MCD and ranged from 1% for congestive heart failure to 5.9% for pneumonia. These complications data can be valuable for preoperative patient counseling and informed consent.

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KW - CHF = congestive heart failure

KW - CVA = cerebrovascular accident

KW - DVT = deep venous thrombosis

KW - elderly patients

KW - ICD-9-CM = International Classification of Diseases, 9th Revision, Clinical Modification

KW - major medical complications

KW - MCD = Centers for Medicare & Medicaid Services claims database

KW - Medicare claims database

KW - MI = myocardial infarction

KW - NIS = National (Nationwide) Inpatient Sample

KW - NSQIP = National Surgical Quality Improvement Program

KW - PE = pulmonary embolism

KW - SMD = surgeon-maintained database

KW - SRS = Scoliosis Research Society

KW - surgeon-maintained database

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